General Information IMPORTANT: This is an application for a Claims-Made and Reported Policy. The Policy issued by Lawyers’ Mutual Insurance Company EXCLUDES coverage for your prior acts. This means that the Company will not defend or indemnify you for any claim arising out of an act, error or omission which occurred prior to the Policy effective date. However, prior acts coverage is available upon request and approval with submission of proof of current coverage.
This Policy WILL NOT PROVIDE COVERAGE for any actual or potential CLAIMS KNOWN to any applicant/insured PRIOR TO THE INCEPTION OF THIS POLICY, including matters disclosed on this application. Any such claims should be reported to your current carrier prior to expiration of your current Policy.
Principal/Business Address * Are you looking for work through a California Certified Lawyer Referral Service? * Name(s) of California State Bar Certified lawyer referral service(s) you are seeking coverage for:
Does the Firm have a satellite office(s)? If yes, provide address(es)
Is the Applicant Lawyer a Solo Practitioner? * List all Predecessor Firm names with years used for endorsement *
Does the firm employ any provisionally licensed attorneys? List all Predecessor Firm names with years used for endorsement; Predecessor Firm Name & Years Used for Endorsement
Areas of Practice Areas of Practice Additional Information Provide a brief description for each of the firm’s areas of practice denoted with an * (asterisk).
By checking this box, you confirm that this work is a Neutral. *
Entertainment Law description *
For each lawyer practicing Entertainment Law, list their name and years practicing in the Entertainment Law field *
In what fields of Entertainment law does your firm provide legal services, including but not limited to Sports law services *
Involvement in making, or arranging for, the capitalizing or financing of the production or distribution of any motion picture or other Entertainment project or venture? * Acting as an agent or manager for any Entertainment/Sports client, including but not limited to actors, musicians, writers, publishers, influencers, professional or amateur athletes or coaches? * Acting in the capacity to negotiate any kind of contract for any Entertainment/Sports client, including but not limited to actors, musicians, writers, publishers, influencers, professional or amateur athletes or coaches? * Negotiating any terms of any personal appearance, sponsorship, merchandising, publishing, licensing, royalty, or franchising agreement on behalf of any Entertainment/Sports client? * Accepted non-monetary compensation for legal services for Entertainment/Sports clients? * Does the Firm (or any of its members or employees) handle funds, write checks, or provide financial or other non-legal services to Entertainment/Sports clients? * Does the Firm (or any of its members or employees), have a business relationship (other than attorney client) with any Entertainment/Sports client? * If the Firm answered “Yes” to any of the 6 questions above, please describe for our Underwriters to better understand the risk: *
Claims Experience 1) After inquiry of all Lawyers in the firm, does the Applicant have knowledge of any act, error, omission or disagreement which might reasonably give rise to a claim or suit? * 1) Does the Applicant have knowledge of any act, error, omission or disagreement which might reasonably give rise to a claim or suit? * 1) After inquiry of all Partners in the Firm, does Applicant have knowledge of any act, error, omission or disagreement which might reasonably give rise to a claim or suit? * 1) Has the Applicant Lawyer ever withdrawn or had declined an application for any professional liability policy, or ever had any such policy non-renewed, cancelled, rescinded or had coverage restricted? * 2) Have any claim(s) been made against Applicant or any current or former Lawyers arising from the performance of professional services during the past 10 years? * 2) Has any claim or disciplinary proceedings been made against Applicant arising from the performance of professional services during the past 10 years? * 2) Have any claims been made against the Firm or any current Partners arising from the performance of professional services during the past 5 years? * 2) Does the Applicant Lawyer have knowledge of or reason to suspect any act, error, omission or any disagreement with any former or current client, employer or third party or dissatisfaction with services rendered or fees charged, which might reasonably give rise to a claim or suit against the Applicant Lawyer? * 3) Has the Applicant Lawyer ever had any claim made against him or her alleging any liability arising from the performance of professional services? * One of our Underwriters will follow up with you for additional information.
3) Has Applicant or any current or former Lawyer at the Firm ever withdrawn or had application declined for any professional liability policy or ever had any such policy non-renewed, cancelled, rescinded or coverage restricted? * 3) Has Applicant ever withdrawn or had an application declined for any professional liability policy or ever had any such policy non-renewed, cancelled, rescinded or coverage restricted? * 3) In the past 5 years, has the Firm’s professional liability policy been non-renewed, cancelled, or rescinded? * 4) Have any disciplinary proceedings been brought by the State Bar of California or any other state bar against any current or former Lawyer at the Applicant Firm? * 4) Have any disciplinary proceedings been brought by the State Bar of California or any other state bar against any current Partner at the Applicant Firm in the last 5 years? * 4) Has the Applicant Lawyer ever had or defended a claim against him or her and not reported it to an insurance carrier? * 5) Has the Applicant or any Lawyer at the Firm been sued for fees during the past 5 years? * 5) Has any Lawyer at the Firm been charged or convicted of a felony offense? * 5) Has the Applicant Lawyer sued for fees during the past 3 years? * 4) Has the Applicant or any Lawyer at the Firm been sued for fees during the past 5 years? * 6) Briefly describe the Firm’s billing collection procedures: *
6) Has any disciplinary proceeding (including but not limited to reprimand, reproval, probation, suspension or disbarment) ever been brought by the State Bar of California, or any other State Bar, against the Applicant Lawyer? * 7) Has the Applicant Lawyer ever been refused admission to practice before any court or administrative agency? * 7) Has any Lawyer at the Firm been charged/convicted of any State or Federal offense? * 5) Has any Lawyer at the Firm been charged/convicted of any State or Federal offense? * 8) Has the Applicant Lawyer ever been charged or convicted of any state or federal offense? *
Limits & Deductibles What was the Applicant Lawyer’s gross revenue from legal services for each of the last three years?
Upon approval of this LILP Application, the Limits of Liability for the LILP policy will be $100,000 each claim/$100,000 annual aggregate with a $250 per claim deductible. No additional limit or deductible options will be available.
Has the Applicant Lawyer been covered by professional responsibility insurance for his/her legal services as a solo practitioner in the past one year? If yes, prior acts coverage will not be offered to new applicants. * By checking this box you confirm you understand this coverage is limits to referrals received from the California State Bar Certified Lawyer Referral Services identified in this application. *
Firm Management a) Engagement letter on new matters outlining scope of representation & billing procedures b) Declination or non-engagement letter on new matter not undertaken c) Scope of service letter for new matters handled for existing clients c) Termination or disengagement letters at completion/termination of representation d) Termination or disengagement letters at completion/termination of representation
2) Does the Firm use a procedure to protect valuable and irreplaceable documents? 4) If a conflict or potential conflict exists are written disclosures made? 7) Does the Firm have a back-up attorney in the event of leave of absence? 7) Does the Firm employ dual calendaring systems? Select all applicable. 8) Does the Firm employ dual calendaring systems? Select all applicable. 8) Is the calendar control system assigned to one staff person who has ultimate responsibility? 10) Are Associates assigned to work under one Partner? 11) Does any Lawyer at the Firm serve as a director, officer or trustee of a business other than the Applicant Law Firm? * if Yes, provide position held, length of service, nature of business and whether D&O coverage carried.
12) Has any Lawyer at the Firm represented or served as director, officer, executive or committee member of any financial institution in any manner in last 5 years? * 13) Does any Lawyer at the Firm act in the capacity of accountant, insurance broker, real estate agent or entertainment agent? * If Yes, explain and provide information on any other E&O coverage *
Does Applicant Lawyer have a system for cross-referencing his/her own client list in order to prevent potential conflicts of interest? Does the Firm employ dual calendaring systems? Select all applicable.
Disclosure & Signature The forgoing responses are true and complete. Applicant understands that the Company will rely upon the accuracy of this application and that the Company retains the right to rescind any Policy which is issued based upon an application containing false or incomplete information. Applicant hereby authorize the release and exchange of information involving underwriting and claims matters between the Company and our past and present carriers and appoints the Company our attorney-in-fact for obtaining such information. Applicant hereby authorizes the State Bar of California to release information to the Company concerning membership, certifications, and disciplinary proceedings. Applicant agrees any person or organization furnishing information to the Company pursuant to this authorization will not be liable for furnishing such information, even if the information is inaccurate or untrue.
THIS APPLICATION WILL BE CONSIDERED ONLY IF ALL QUESTIONS ARE ANSWERED, LETTERHEAD IS ATTACHED, AND THE APPLICATION IS SIGNED AND DATED BY AN OWNER, PARTNER OR OFFICER OF THE APPLICANT FIRM. APPLICANT MUST REPORT ANY CHANGES IN THESE ANSWERS OF WHICH IT BECOMES AWARE AFTER SIGNING THIS APPLICATION BUT BEFORE THE EFFECTIVE DATE OF THE POLICY. IF APPLICANT BECOMES AWARE OF ANY ACTUAL OR POTENTIAL CLAIM AFTER SIGNING THIS APPLICATION AND BEFORE THE EFFECTIVE DATE OF THE POLICY, SUCH ACTUAL OR POTENTIAL CLAIM WILL NOT BE COVERED UNDER THIS POLICY.
For clarification, please contact our underwriters at 1-800-252-2045
Preferred Method of Contact Signature * Application Certified * I certify that the above information is true and correct. *